Last week I had the pleasure of speaking at the 2013 Hawaii Health Workforce Summit focused on improving provider satisfaction and practice sustainability. A 2010 assessment performed by the John A. Burns School of Medicine revealed a shortage of more than 600 practicing physicians, 60 physician assistants and 180 nurse practitioners. Data for this year indicate that the situation continues to deteriorate. In Hawaii the number of working physicians is expected to drop while the population continues to grow and age.
Increasing numbers of physicians are burning out and choosing to retire or leave the islands because of financial challenges that make it difficult to maintain a meaningful and rewarding practice. The push to change to electronic health records, combined with increasingly rigorous compliance standards and limited reimbursement, is causing physicians to opt out at a time when we need more health professionals. What can Hawaii do to ensure that there will be enough medical providers in the islands in the years to come?
Our panel of "happy physicians" was asked to present at the conference to provide support and offer information about how a provider might thrive under the current conditions. At one point we were asked to discuss how to be successful when adopting electronic health records, which lays the foundation for other change.
1. Resistance is futile: Electronic health records are rapidly becoming the norm. There are now multiple incentives to make the change, but soon the incentives to adopt EHR will turn into penalties for those who do not.
2. Choose wisely: The only work-flow change that is harder than going from paper to electronic records is going from one system to the other. Switching costs are enormous. Be sure to choose a proven company with a large number of practices already on board and with a commitment to service in the islands.
3. Nurture staff: Staff turnover is almost inevitable during an EHR transition, but it can be minimized with careful advance planning, adequate training and heartfelt support.
4. Opportunity costs dwarf system costs: The hard costs of the electronic health record system are dwarfed by the need to see fewer patients during the switch combined with staff time involved in making the change. The full transition takes one year.
5. Don’t scan old records: It is impractical to scan all of the old records so they become readable on EHR. The time and cost are great, and the result can be impractical. Scrolling through old paper charts is much harder than thumbing through an actual paper record. Just pull the old charts when seeing patients on the new EHR until they are no longer needed, and then store them.
6. It’s only chump change: Incentives paid by insurance, including Medicare, don’t come close to covering the total cost of the capital expense, process re-engineering, downtime, opportunity costs and ongoing administrative resources required to maintain compliance with new requirements as set forth by payers.
"Make or buy" or "insource outsource" decisions are also critical, particularly with regard to medical billing. Outsourcing is usually simpler but results in less control. More control comes with a higher risk-reward profile.
The most crucial factor in provider satisfaction, however, is not money, but relationship. If the dynamic changes in health care can be harnessed to support the sacred physician-patient bond, all concerned will benefit. If not, the investment is hollow.
It is also essential to maintain clear professional boundaries. Postponing "paperwork" until the weekend or making multiple patient calls into the evening can be draining and discouraging. Providers who routinely complete all the moving parts of each visit right then and there tend to do better.
Physicians also must stay connected to the place where we live and the community we practice in. We have all heard the ancient adage, "Physician, heal thyself."
So how is that done?
Commune with the aina and the kai.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
